Reversal of complete atrioventricular block in dialysis patients following parathyroidectomy:A case report

BACKGROUND Refractory secondary hyperparathyroidism(SHPT)is a common complication observed in patients with end-stage renal disease and can result in ectopic calcification.Metastatic calcification involving the heart valves and the conduction system can easily lead to arrhythmias,including atrioventricular block.This case report describes a maintenance hemodialysis patient with refractory SHPT resulting in a complete atrioventricular block(CAVB),which was eventually reversed to a first-degree atrioventricular block.CASE SUMMARY We present the case of a 31-year-old Asian female who was receiving maintenance hemodialysis because of lupus nephropathy.She developed SHPT,and an electrocardiogram revealed a first-degree atrioventricular block.Then,she underwent parathyroidectomy(PTX)with autotransplantation.Unfortunately,a few years later,she developed SHPT again,and an electrocardiogram revealed a CAVB.A few years after the second PTX surgery,the calcification of the left atrium and left ventricle improved,and her CAVB was reversed.CONCLUSION This case revealed that metastatic cardiac calcification can result in complete atrioventricular blockage.Following parathyroid surgery,calcification of the cardiac conduction system improved,leading to reversal of the atrioventricular block.It is important for dialysis patients to optimize intact parathyroid hormone therapy and pay attention to calcification metastasis.

Assessing the Impact of General Anesthesia and Bronchial Intubation in Conjunction with Thoracic Paravertebral Nerve Block on Cellular Immunity and Surgical Management in Tuberculous Pyothorax Patients

Objective:This study aims to investigate the impact of combining general anesthesia with bronchial intubation and thoracic paravertebral nerve block during surgery for patients with tuberculous pyothorax.Methods:Eighty patients diagnosed with tuberculous pyothorax,admitted to the hospital between January 2023 and September 2023,were randomly selected for this study.The patients were divided into control and study groups using a numerical table method.The control group underwent general anesthesia with bronchial intubation,while the study group received general anesthesia with bronchial intubation in conjunction with thoracic paravertebral nerve block.Subsequently,the patients were monitored to assess mean arterial pressure,heart rate variations,and adverse reactions to anesthesia.Results:The study group exhibited significantly lower mean arterial pressure and heart rate levels during the post-surgical incision,immediate end of surgery,and immediate extubation periods compared to the control group(P<0.05).Furthermore,the Ricker and Ramsay scores in the study group were significantly lower than those in the control group(P<0.05).Conclusion:The combined use of general anesthesia via bronchial intubation and thoracic paravertebral nerve block has been found to stabilize mean arterial pressure and heart rate while providing effective sedation for surgical treatment in patients with tuberculous septic thorax.

下颌骨后缩伴前牙正常覆盖青少年患者Twin-block治疗效果分析

目的:了解改良固定式Twin-block对下颌骨后缩伴正常覆盖患者的治疗效果。方法:选择下颌骨后缩伴前牙正常覆盖青少年患者36例,咬合重建目标为软组织颏前点前移达零子午线,采用改良固定式Twin-block联合下颌外斜线微种植支抗钉促进下颌骨生长,12个月后分步拆除矫治器,观察颌位的稳定性,固定矫治调整咬合关系,改善侧貌。采用SPSS 13.0软件包对功能矫治前后以及固定矫治前后所测数据进行配对t检验。结果:治疗结束后,颏前点明显前移,下颌体长度明显增加,患者侧貌由凸面型变为直面型。功能矫治前后比较结果显示,Co-Gn、SNB、U1-SN、U6-0°、U1-0°、U1-L1、前牙覆[牙合]、覆盖、Pog’s-0°、L1-0°及面下1/3高度均发生明显变化(P<0.05);固定矫治前后比较结果显示,PP-MP、SN-MP、U6-0°、IMPA、L1-0°、U1-SN、U1-L1、前牙覆[牙合]、覆盖发生明显变化(P<0.05)。结论:改良固定式Twin-block联合微种植钉可有效改善下颌骨后缩伴正常覆盖患者的侧貌。

Ticagrelor therapy and atrioventricular block:Do we need to worry?

Ticagrelor is a potent,direct P2Y12 antagonist with rapid onset of action and intense platelet inhibition,indicated in patients with acute coronary syndromes(ACS).This drug is usually well tolerated,but some patients experience serious adverse effects:Major bleeding;gastrointestinal disturbances;dyspnoea;ventricular pauses > 3 s.Given the unexpected high incidence of bradyarrhythmias,a PLATO substudy monitored this side effect,showing that ticagrelor was associated with an increase in the rate of sinus bradycardia and sinus arrest compared to clopidogrel.This side effect was usually transient,asymptomatic and not associated with higher incidence of severe atrioventricular(AV) block or pacemaker needs.A panel of experts from Food and Drug Administration did not consider bradyarrhythmias a serious problem in clinical practice and,accordingly,current labeling of the drug does not give any precaution or contraindication regarding this issue.However,recently some articles have described ACS patients with high-degree,life-threatening,AV block requiring drug discontinuation and,in some cases,pacemaker implantation.In this paper,we describe and discuss five published case reports of severe AV block following ticagrelor therapy and two other cases managed in our Hospital.The analysis of literature suggests that,although rarely,ticagrelor can be associated with lifethreatening AV block.Caution and careful monitoring are required especially in patients with already compromised conduction system and/or treated with AV blocking agents.Future studies,with long-term rhythm monitoring,would help to define the outcome of patients at higher risk of developing this complication.

A rare case of Staphylococcus lugdunensis septicemia associated with myocarditis and atrioventricular block

Myocarditis is a relatively rare,possibly life-threatening disease characterized by the inflammation of the myocardium.111 The disease pathogenesis is primarily initiated by acute injury and necrosis of cardiomyocytes,leading to an inflammatory response mediated by the immune system that can potentially cause further aggravation of myocardial damage and organ dysfunction.Prognosis in patients with myocarditis depends on the clinical presentation,which ranges from an asymptomatic disease course to the concomitant development of cardiac arrhythmias,heart failure,cardiogenic shock and even the occurrence of death in extreme cases[1].

Identification of a New Lamin A/C Mutation in a Chinese Family Affected with Atrioventricular Block as the Prominent Phenotype

Even though mutations in LMNA have been reported in patients with typical dilated cardio-myopathy(DCM)and atrioventricular block(AVB)previously,the purpose of this study was to disclose this novel genetic abnormality in one Chinese family with the atypical phenotype of progressive AVB followed by DCM with normal QRS interval.Genome-wide linkage analysis mapped the AVB gene in this family to a marker at chromosome 1q21.2,where the LMNA gene was located.Direct DNA sequence analysis revealed a heterozygous G t...

Tako-tsubo syndrome after administration of intravenous adrenaline during atrioventricular block

We describe the clinical case of a 70-year-old woman with complete atrioventricular block that after administration of intravenous adrenaline, developed electrocardiographic changes suggestive of acute coronary syndrome, together with apical dyskinesia of the left ventricle. After ruling out the existence of coronary lesions, and after total recovery of the echocardiographic alterations in segmental contractility, she was diagnosed as Tako-tsubo syndrome induced by administration of adrenaline. This is the first report of this syndrome in the scenario of atrioventricular block treated with adrenaline infusion.

比较MRC肌功能训练器与Twin-block矫治器治疗安氏Ⅱ类1分类错患者软组织侧貌变化

目的 研究MRC和Twin-block两种矫治器治疗安氏Ⅱ类1分类错患者软组织侧貌变化。方法 选择24例替牙晚期或恒牙早期的安氏Ⅱ类1分类错患者进行分组治疗,其中MRC肌功能训练器组患者12例,Twin-block矫治器组12例。在矫治前后摄取X线头颅侧位片,并对治疗前后的头影测量相关参数值进行统计分析,进而比较两组患者软组织侧貌变化情况。结果 治疗后,MRC和Twin-block两组患者的Ns-Me’, Sn-Me’,CmSnLs,A’Ls-FH, B’Li-FH, LiB’Pg’,NsPg’-FH, GSnPg’, Z角均增大;差异具有统计学意义(P<0.05)。Ls-E,Li-E,Pg’B’-FH,H角均减小,差异具有统计学意义(P<0.05);Ns-Sn差异无统计学意义(P>0.05)。结论 在儿童颌面部生长发育期间,应用MRC肌功能训练器和Twin-block矫治器治疗安氏Ⅱ类1分类错患者临床效果基本相同,有改善面部软组织及侧貌的作用。

Completed atrioventricular block induced by atrial septal defect occluder unfolding:A case report

BACKGROUND An atrial septal defect is a common condition and accounts for 25%of adult congenital heart diseases.Transcatheter occlusion is a widely used technique for the treatment of secondary aperture-type atrial septal defects(ASDs).CASE SUMMARY A 30-year-old female patient was diagnosed with ASD by transthoracic echocardiography(TTE)1 year ago.The electrocardiogram showed a heart rate of 88 beats per minute,normal sinus rhythm,and no change in the ST-T wave.After admission,TTE showed an atrial septal defect with a left-to-right shunt,aortic root short-axis section with an ASD diameter of 8 mm,a parasternal four-chamber section with an ASD diameter of 9 mm,and subxiphoid biatrial section with a diameter of 13 mm.Percutaneous occlusion was proposed.The intraoperative TTE scan showed that the atrial septal defect was oval in shape,was located near the root of the aorta,and had a maximum diameter of 13 mm.A 10-F sheath was placed in the right femoral vein,and a 0.035°hard guidewire was used to establish the transport track between the left pulmonary vein and the inferior vena cava.A shape-memory alloy atrial septal occluder with a waist diameter of 20 mm was placed successfully and located correctly.TTE showed that the double disk unfolded well and that the clamping of the atrial septum was smooth.Immediately after the disc was revealed,electrocardiograph monitoring showed that the ST interval of the inferior leads was prolonged,the P waves and QRS waves were separated,a junctional escape rhythm maintained the heart rate,and the blood pressure began to decrease.After removing the occluder,the elevation in the ST segment returned to normal immediately,and the sinus rhythm returned to average approximately 10 min later.After consulting the patient’s family,we finally decided to withdraw from the operation.CONCLUSION Compression of the small coronary artery,which provides an alternative blood supply to the atrioventricular nodule during the operation,leads to the emergence of a complete atrioventricular block.

A Case of Transient Advanced Atrioventricular Block after Aortic Valve Replacement, Report of a Case

Approximately 3%-11.8% of cases require permanent pacemaker implantation due to atrioventricular block (AVB) after aortic valve replacement (AVR), and determination of conduction disturbances such as left or right bundle branch block by preoperative electrocardiography is correlated with high risk postoperative permanent pacemaker implantation. Intraoperative risk factors include severe calcification of the aortic valve, prolonged cardiopulmonary bypass time, aortic clamp time. Recently, there have been reports of high rates of pacemaker implantation (14.2%) after transcatheter aortic valve implantation. The time of permanent pacemaker implantation after AVB is often 4-10 days, and the European Society of Cardiology guidelines recommend a period of seven days of persistent atrioventricular block postsurgery prior to permanent pacemaker implantation. We report a 79-year-old woman in which the patient developed high-degree AVB after AVR was performed for severe aortic stenosis with complete right bundle branch block. However, her pulse returned to sinus rhythm 7 days postsurgery.

Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database

BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has resulted in a worldwide health crisis since it first appeared.Numerous studies demonstrated the virus’s predilection to cardiomyocytes;however,the effects that COVID-19 has on the cardiac conduc-tion system still need to be fully understood.AIM To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks(BBB).METHODS The 2020 National Inpatient Sample(NIS)database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioven-tricular blocks(HDAVB)and right or left BBB utilizing ICD-10 codes.The patients with pre-existing pacemakers,suggestive of a prior diagnosis of HDAVB or BBB,were excluded from the study.The primary outcome was inpatient mortality.Secondary outcomes included total hospital charges(THC),the length of hospital stay(LOS),and other major cardiac outcomes detailed in the Results section.Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17.RESULTS A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database,of which 3210(0.4%)and 17365(1.6%)patients were newly diagnosed with HDAVB and BBB,respectively.We observed a significantly higher odds of in-hospital mortality,cardiac arrest,cardiogenic shock,sepsis,arrythmias,and acute kidney injury in the COVID-19 and HDAVB group.There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism.Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias,acute kidney injury,sepsis,need for mechanical ventilation,and cardiogenic shock than those without BBB.However,unlike HDAVB,COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB.CONCLUSION In conclusion,there is a significantly higher odds of inpatient mortality,cardiac arrest,cardiogenic shock,sepsis,acute kidney injury,supraventricular tachycardia,ventricular tachycardia,THC,and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB.Likewise,patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia,atrial fibrillation,atrial flutter,ventricular tachycardia,acute kidney injury,sepsis,need for mechanical ventilation,and cardiogenic shock as compared to those without BBB.Therefore,it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.

Chinese and Western medicine treatment of blocking antibody in recurrent spontaneous abortion

The causes of recurrent spontaneous abortion are complex traditional Chinese medicine holds that its etiology is losses of spleen and kidney qi, qi and xue deficiency, in addition to secretion, genetic, anatomical, infection, systemic diseases, environmental factors and other related immune factors, the deficiency of blocking antibody is also one of the reasons for the lack of immune factors. In treating it, Chinese medicine treatment combines the patients personal constitution and treatment based on syndrome differentiation; Western medicine treatment mainly applies Aspirin, active immune lymphocyte treatment, low molecular heparin, gamma globulin protein passive immune treatment and psychological intervention therapy. In this paper, a review of the treatment methods for closed antibodies in the past 5 years is made.

油田含聚废液处理及再利用技术研究

近年来虽然对聚合物驱油藏油水井洗井、作业及站内管线清洗产生的含聚废液开展了回收再利用技术研究,但缺乏聚合物胶块废液的有效处理技术。为此,结合注聚区废液的特点,研究相应的处理技术,确定注聚区废液的调剖用配方,并针对不同废液改进调剖注入工艺,形成注聚区废液调剖再利用技术。研究结果表明:研制的橇装式含聚废液地面分离及处理装置能够有效分离废液中的胶块,对其进行粉碎处理后,形成颗粒调剖剂,进而实现单井直接注入;结合含聚废液特点,研发了相应的复配调剖剂配方,形成了调剖剂系列,达到了封堵高渗透油藏堵剂要求;现场实施调剖21口井,累计处理废液51 978 m^(3),油压平均上升了1.5 MPa,累计增油达8 036.2 t。研究结果可为油田清洁环保开发生产提供技术依据。

左束支区域起搏对房室传导阻滞患者术后新发房性心律失常的影响

目的探讨左束支区域起搏(left bundle branch area pacing,LBBaP)对房室传导阻滞(AVB)患者术后新发心房颤动(new-onset atrial fibrillation,NOAF)和心房高频事件(atrial high rate episodes,AHREs)的影响。方法回顾性纳入84例行起搏治疗的三度房室传导阻滞(ⅢAVB)患者,根据心室电极位置分为LBBaP组(n=42)和右室间隔部起搏(RVSP)组(n=42)。比较两组患者术前术后QRS波时限(QRSd)、心室起搏参数,并发症、脑卒中事件和NOAF、AHREs发生率。结果(1)LBBaP组术后NOAF、AHREs发生率均低于RVSP组(P<0.05)。(2)LBBaP组的p-QRSd短于RVSP组(P<0.05)。(3)两组患者心室起搏参数、并发症及脑卒中事件发生率之间差异无统计学意义(P>0.05)。结论相对于右室起搏,LBBaP术后AHREs、NOAF的发生率较低,可改善患者预后。

获得性房室传导阻滞的病因学研究进展

房室传导阻滞(AVB)是引起缓慢性心律失常的主要原因。其病因分为遗传性和获得性,其中获得性因素更为常见。近年来,对获得性AVB的病因学进行探讨发现,其病因复杂,主要包括冠心病、退行性疾病、感染性疾病、风湿性或自身免疫性疾病、浸润性疾病、自主神经功能异常、甲状腺功能减退、高钾血症等。因此,早期明确获得性AVB的病因至关重要,可为其治疗提供针对性策略,以改善预后。随着现代诊疗技术的发展,更多获得性AVB病因的发现将会为其治疗提供新思路。

Twin-block矫治器早期矫治安氏Ⅱ类1分类错的临床效果

目的研究Twin-block矫治器治疗快速生长期安氏Ⅱ类1分类错患者的临床效果。方法选择30名快速生长期安氏Ⅱ类1分类错患者作为研究对象,治疗组18例采用Twin-block矫治器治疗,对照组12例未作矫治。治疗组治疗前后、对照组观察开始和结束时分别拍摄头颅侧位片,采用Pancherz分析法进行分析。结果与对照组相比,治疗组ANB角、前牙覆盖、磨牙关系、下颌基骨位置、髁突位置和下颌长度的变化均有统计学意义(P<0·05),而上颌基骨位置的变化无统计学意义(P>0·05)。前牙覆盖减小和磨牙关系改善主要来源于骨骼效应。结论Twin-block矫治器治疗生长快速期安氏Ⅱ类1分类错患者,可有效改善前牙覆盖和磨牙关系。这种改善包括骨骼效应和牙齿效应,其中下颌骨矢状方向的生长较为显著。

永久起搏器植入术后2年心房电极穿孔一例

1病例资料患者男性,70岁,因“胸痛8 h余”于2023年1月8日入院。患者入院前8 h无诱因出现胸痛,位于胸骨后,呈绞痛,深呼吸时疼痛加重,持续不缓解,伴胸闷、气短、乏力,无恶心、呕吐,无黑矇、晕厥等。既往于2020年7月27日因“二度Ⅱ型房室传导阻滞”于我院植入永久起搏器(Medtronic Advisa A3DR01 DDDR,Medtronic),起搏器电极型号:右心房Medtronic 5076-52,右心室Medtronic 5076-58,起搏器程控参数见表1。2020年冠状动脉CT血管成像(computed tomography angiography,CTA)检查提示,冠状动脉粥样硬化性心脏病,双支血管病变(前降支中段狭窄50%,回旋支远段狭窄75%),纵隔肿物。建议行冠状动脉造影检查及进一步明确纵隔占位病变性质,患者均拒绝。

改良固定反式Twin-block矫治器治疗早期AngleⅢ错

目的 :将改良固定反式Twin -block矫治器用于矫治早期AngleⅢ错牙合 ,并评价其临床应用效果。方法 :应用反式Twin -block矫治器治疗 1 2例处于生长发育期AngleⅢ错牙合 ,比较矫治前后的临床表现及X线投影测量结果。结果 :经 4～ 6个月的治疗 ,患者正、侧面轮廓明显改善 ,前牙反覆盖反覆牙合得以矫治 ,磨牙关系为AngleⅠ类。结论 :反式Twin -block矫治器能迅速有效矫治早期AngleⅢ错牙合 ,且制作更为简单 ,结构小巧 。

固定式Twin-block矫治青春期骨性Ⅱ类错[牙合]的临床效果评价

目的:评价固定式Twin-block矫治器的固位效果及治疗青春期骨性Ⅱ类错[牙合]的临床疗效。方法:选取26例(男12例,女14例)青春期骨性Ⅱ类1分类错[牙合]畸形患者(年龄11~13岁,平均11.8岁),采用固定式Twin-block矫治器引导下颌骨前伸,疗程1年。治疗前、后拍摄头颅定位侧位片,观察患者的骨性、牙性及软组织变化。采用Graphpad Prism 6.0软件对治疗前、后数据进行配对t检验。结果:治疗中未出现矫治器松动、破坏,所有病例侧貌获得明显改善。发生显著变化的指标有:下颌骨长度和位置(Co-Gn、SNB、ANB、Pog-VL、Pos-VL),上前牙位置和倾斜度(U1-VL,U1-SN),下牙列矢状向位置(L1-VL、L6-VL)(P<0.05);变化不显著的指标有:下颌平面角(MP-SN),上颌骨位置和长度(SNA、A-VL),上前牙垂直向位置(U1-HL),上后牙位置(U6-VL、U6-HL),下前牙倾斜度(IMPA),下牙列垂直向位置(L6-MP、L1-MP)(P>0.05)。结论:固定式矫治器Twin-block可增强下颌支抗,有效促进下颌骨生长,改善患者侧貌。

希氏束起搏与右心室心尖部起搏对房室传导阻滞患者心脏结构学参数与功能学参数影响的临床研究

目的:探究希氏束起搏(HBP)与右心室心尖部起搏(RVAP)对房室传导阻滞(AVB)患者心脏结构学参数与功能学参数的影响。方法:选取收治的104例AVB患者为研究对象,随机分为HBP组和RVAP组各52例,HBP组行HBP治疗,RVAP组行RVAP治疗,比较两组术前、术后心脏结构学参数、心脏起搏参数、心率和血流动力学参数[心率(HR)、每搏输出量(SV)、心脏指数(CI)和左室射血分数(LVEF)]及QRS时限变化情况。结果:两组手术前后心脏结构学参数左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)比较,差异均无统计学意义(均P>0.05);术中、术后1个月、术后6个月心脏起搏阈值、R波幅度、电极阻抗比较无统计学差异(均P>0.05);术前、术后1个月,两组HR、SV、CI、LVEF、QRS时限比较无统计学差异(均P>0.05);术后6个月,HBP组HR、SV、CI、LVEF显著高于RVAP组(均P<0.05),RVAP组QRS波时限显著低于HBP组(P<0.05);结论:HBP对AVB患者的电-机械同步性优于RVAP,近期心脏血流动力学及心功能稳定性良好。